Korean J Radiol.  2009 Jun;10(3):303-306. 10.3348/kjr.2009.10.3.303.

Giant Vertebral Notochordal Rest: Magnetic Resonance and Diffusion Weighted Imaging Findings

• Oner AY
• Akpek S
• Tali T
• Ucar M

• KMID: 1779458
• DOI: http://doi.org/10.3348/kjr.2009.10.3.303

Abstract

A giant vertebral notochordal rest is a newly described, benign entity that is easily confused with a vertebral chordoma. As microscopic notochordal rests are rarely found in adult autopsies, the finding of a macroscopic vertebral lesion is a new entity with only seven previously presented cases. We report here radiological findings, including diffusion weighted images, of a patient with a giant notochordal remnant confined to the L5 vertebra, with an emphasis on its distinction from a chordoma.

Keyword

Notochord; Chordoma; Diffusion weighted imaging; Magnetic resonance (MR)

MeSH Terms

Chordoma/*diagnosis
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging/methods
Female
Humans
Low Back Pain/etiology
Lumbar Vertebrae/pathology/radiography
Magnetic Resonance Imaging/*methods
Middle Aged
Notochord/*pathology/radiography
Physical Therapy Modalities
Spinal Neoplasms/*diagnosis/therapy
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Sagittal T1- (A) and T2-weighted (B) MR images reveal well defined large intraosseous lesion with low T1 and high T2 signal within L5 vertebral body. There is no sign of bone destruction or adjacent soft tissue extension. Sagittal T2- (C), pre- (D) and post-contrast T1 weighted (E) images taken one year after patient first presented fail to reveal any changes in lesion size or characteristics. There is no soft tissue extension or enhancement following intravenous contrast injection. Diffusion weighted image obtained at same sagittal plane using single shot fast spin-echo technique at b = 600 sec/mm2 (F), and corresponding apparent diffusion coefficient map (G) show high signal intensity over lesion mostly influenced by T2 shine-through effect. Apparent diffusion coefficient measured over lesion is 1.55±0.24×10-3 mm2/sec. Compared to apparent diffusion coefficient value of normal L3 vertebral body (0.38±0.16×10-3 mm2/sec), this finding fails to reveal any diffusion restriction. CT image of L5 vertebra reformatted in sagittal plane (H) shows central mild trabecular sclerosis confined to vertebral body. Note that cortex is intact and there is no osseous destruction.

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